POS0550 IMMUNE RESPONSE AFTER VACCINATION AGAINST SARS-COV2 IN PATIENTS WITH IMMUNOMEDIATED DISEASES (RIM-COV PROJECT)
Authors: A. Boteanu, V. Garcia Garcia, N. Villarrubia Migallón, A. Corral Bote, A. M. Ruiz Bejerano, J. Arroyo Palomo, P. Garcia Casado, R. Rodríguez Ramos, L. M. Villar, M. J. Rodríguez Dominguez, A. Muriel García, C. Guillén-Astete, M. Á. Blázquez, J. Bachiller-Corral, M. Vázquez Díaz
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> It is known that patients with immunomodulatory treatment may have less immune response to vaccines. Since SARS-CoV2 infection appeared, several vaccines have been developed. In previous studies, it has been observed that some subgroups of patients has a lower antibody response after SARS-Cov2 vaccination, especially patients treated with Rituximab (an anti-CD20 monoclonal antibody); but also in those treated with Mycophenolate Mofetil, Abatacept, JAK inhibitors, anti tumor necrosis factor (TNF) α, Methotrexate or Glucocorticoids. In some studies, an absence of humoral response but the presence of a T-cell response after vaccination has been observed in patients with B-cell depletion, even without finding differences between patients treated with rituximab compared with other immunomodulatory therapies or healthy controls. As well, it has been described a lower T-cell response in patients treated with anti-CTLA4, anti-interleukin 6 or antiTNFα. <h3>Objectives</h3> Our objective is to identify factors that influence humoral and cellular immune responses to SARS-CoV-2 vaccines in patients with immune-mediated rheumatic diseases (IMRDs) in treatment with disease-modifying anti-rheumatic drugs (DMARDs) and in healthy subjects as a control. <h3>Methods</h3> A total of 140 consecutive patients and 24 healthy controls were included in this observational cross-sectional single-centre study. Two months after second or third COVID-19 vaccine dose (BNT162b2 [Pfizer/BioNTech], mRNA-1273 [Moderna] or AZD1222 [AstraZeneca]), we quantified IgG anti-SARS-CoV-2 antibodies by chemiluminescent immunoassay of micro-particles and Interferon (IFN)-gamma production by T cells stimulated with SARS-CoV-2 peptides using an IFN-gamma release assay test. IgG anti-SARS-CoV-2 levels below 1800 AU/ml or IFN-gamma levels below 0.15 IU/ml were considered as a suboptimal humoral or cellular immune response, respectively. Multivariate analyses were used for exploring influence of different factors in these suboptimal immune responses. <h3>Results</h3> Of the140 patients, 101 were women and 39, men, with a median age of 55.9 (46.1-69.7) years and a disease duration of 13 years (6-20.8). 106 patients had a diagnosis of autoimmune arthropathy and 34, of systemic autoimmune disease. The higher risk of having a poor humoral response after the vaccination was shown in those patients receiving only two vaccine doses (OR: 7.83 (2.94-20.83); p&lt;0.0001), patients with diagnosis of systemic autoimmune disease (OR: 4.73 (1.47-15.21); p=0.009) or patients receiving treatment with Rituximab (OR: 13.17 (3.68-47.11); p&lt;0.0001). There was a moderate association between suboptimal cellular immune response and older age (OR: 1.03 (1.01-1.05); p &lt; 0.01). Receiving only two vaccine doses (OR: 4.02 (1.7- 9.5); p&lt;0.001) and older age (OR: 1.04 (1.01-1.07); p&lt;0.006) were associated with both suboptimal antibody and cellular immune responses to SARS-CoV2 vaccines, without agreement between both immune responses (kappa factor=0.198). <h3>Conclusion</h3> This study allows the early identification of suboptimal responders to SARS-CoV2 vaccines among patients with IMRDs who receive immunomodulatory therapy, and shows the need of a booster dose in elderly patients and, maybe, in patients with systemic autoimmune disease or those who are treated with Rituximab. Future studies demonstrating if these suboptimal immune responses are associated to more severe COVID-19 are required. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.